NPIMap

Organization Active NPI

Ste. Genevieve County Memorial Hospital

  • General Practice Physician
  • Bloomsdale, MO
National Provider Identifier
1194075200
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
Practice address
255 Boderman
Suite 2a
Bloomsdale, MO 63670
Phone
(573) 883-4473
Fax
(573) 883-4472
NPI assigned
Sep 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda Wolk
Title
Business Office Director
Phone
(573) 883-7703

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

255 Boderman
Suite 2a
Bloomsdale, MO 63670

Mailing address

PO Box 366
Ste Genevieve, MO 63670-0366
Phone (573) 883-4473

Other names 1

  • Specialty Clinic at Bloomsdale Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040102000645 MO Part B Supplier - Clinic/Group Practice 3274432802 Receives reassigned benefits from 66 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bloomsdale, MO; Ste Genevieve, MO

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ste Genevieve Co Hospital17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1194075200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636700366",
            "telephone_number": "573-883-4473",
            "fax_number": "573-883-4472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 BODERMAN",
            "address_2": "SUITE 2A",
            "city": "BLOOMSDALE",
            "state": "MO",
            "postal_code": "63670",
            "telephone_number": "573-883-4473",
            "fax_number": "573-883-4472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "WOLK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "573-883-7703"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Specialty Clinic at Bloomsdale",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Specialty Clinic at Bloomsdale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomsdale, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.